Post-stroke seizures and epilepsy

Most studies have not shown an effect of seizures per se on stroke morbidity or mortality,35,37 although this is confounded (especially in hemorrhagic stroke) by mortality in the most severely affected patients before development of seizures.19 There are rare cases of deficits seeming to worsen permanently after a seizure or series of seizures.102 The occurrence of seizures in 15% of stroke rehabilitation patients did not affect functional outcome.108

The prognosis of epilepsy caused by stroke is not clearly different from epilepsy due to other causes, although as a group, elderly patients tend to have better seizure control than younger patients.3 Most series that address this issue indicate that seizures are readily controlled with antiepileptic drugs (AEDs).34,35,84 Whether control differs for ischemic or hemorrhagic stroke is unclear.

Post-stroke epilepsy usually responds well to adequate doses of a single agent. If seizures are completely controlled, AED withdrawal can be considered after 2 years. Risk of recurrence is probably higher among patients with structural lesions and an abnormal examination than among those without, particularly if there were also acute symptomatic seizures.109,110

The potential consequences of a recurrent seizure are highly variable, depending on activities such as driving or medications such as anticoagulants. Just as in deciding whether to start AEDs, the decision to withdraw them must be individualized.

Adapted from: Bromfield, EB, and Henderson GV. Seizures and cerebrovascular disease. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;269–289.
With permission from Elsevier ( 

Reviewed By: 
Steven C. Schachter, MD
Thursday, April 1, 2004